Keywords
1. Candida auris outbreak
2. Multidrug-resistant infection
3. Nosocomial infections
4. Antifungal resistance
5. Infection control Pakistan
The emergence of Candida auris, a multidrug-resistant fungal pathogen, has posed an alarming challenge for healthcare systems across the world. With its ability to swiftly spread within clinical settings and exhibit resistance to multiple antifungal drugs, C. auris has become a focus of concern for clinicians and researchers alike. Pakistan, which has been caught in the throes of this escalating infectious threat since 2014, recently witnessed dedicated efforts by healthcare professionals to scrutinize the clinical spectrum and outcomes of patients affected by C. auris. This meticulously conducted study from Aga Khan University Hospital (AKUH), Karachi, offers a window into both the grim realities and potential ameliorative strategies for tackling this infectious menace.
The study, published in BMC Infectious Diseases (DOI: 10.1186/s12879-019-3999-y), was a retrospective probe into 92 adult patient cases, who had been diagnosed positive for C. auris over the span from September 2014 to March 2017. The detailed examination involved sifting through demographics, medical histories, management protocols, and resultant outcomes. A logistic regression model played a crucial role in identifying mortality risk factors, laying bare the impact of various clinical variables.
Demographic data depicted a relatively equal gender distribution with 52.2% males, and an average patient age of 54 years. The median time it took for C. auris to be detected was 14 days post hospital admission. An overwhelming 95.6% of the cases had exposure to antibiotics, with additional factors like surgical history, ICU stays, and indwelling lines being prevalent.
The clinical presentation varied extensively: 70.7% of the patients exhibited symptoms, candidemia was identified in 38 cases, while non-candidemia infections were observed in 27. The primary sites of infection included central lines, urinary tract, and several other locations, indicating nosocomial transmission pathways. The resistance to common antifungal drugs was startling, with 100% resistance to Fluconazole and considerable resistance to both Voriconazole and Amphotericin B.
Such resistance trends align with findings from other global studies, making C. auris a hardened adversary in the infectious disease landscape. Mortality rates in the AKUH cohort were distressing: 42.4% overall, with candidemia cases notably higher than non-candidemia cases (60.5% vs 25.9%). However, source control, the practice of removing the foci of infection like infected catheters, emerged as a lighthouse of hope, being the only protective factor against mortality.
The study’s Authors’ Information reveals a collaboration among seasoned experts from the Department of Medicine and Microbiology at AKUH, each bringing their academic prowess and clinical insight to this colossal endeavor.
Ethically conducted under the AKUH’s Ethics Review Committee’s approval (with the requirement for informed consent aptly waived considering the retrospective nature of the study), the insights divulged by this research heed to rigorous academic standards. The investigative team meticulously ensured patient confidentiality throughout the data analysis process.
The harrowing figures and the distinct pattern of antifungal resistance emphasize the dire need for urgent measures to prevent and manage C. auris infections. This study reinforces global anecdotes that have long cautioned about the menacing ascendancy of C. auris, documented across continents through intensive research efforts (Jeffery-Smith et al., 2017; Cortegiani et al., 2018; Lee et al., 2011; Satoh et al., 2009).
What marks the efforts at AKUH standout is an interdisciplinary approach combining clinical vigilance with thorough analyses. The study meticulously hewn from Pakistan is both timely and significant, as it not only adds to the global pool of knowledge but offers critical insights specific to local epidemics.
One key takeaway is the stark reminder that vigilance and infection control are paramount. The Centers for Disease Control and Prevention (CDC) and various infectious diseases’ guidelines underscore this reality, providing frameworks that need to be calibrated to local exigencies (Pappas et al., 2016; CDC/NHSN, 2016).
With the publication of this study, the AKUH steps forward as a sentinel, tailed by other national and global healthcare experts, in disseminating pivotal knowledge on the epidemiology of C. auris. Its findings serve as a beacon, guiding policy reform and clinical practices towards improved outcomes for those affected by these complex, resistant infections.
References
1. Sayeed, M. A., Farooqi, J., Jabeen, K., Awan, S., & Mahmood, S. F. (2019). Clinical spectrum and factors impacting outcome of Candida auris: a single-center study from Pakistan. BMC Infectious Diseases, 19(1), 384. doi:10.1186/s12879-019-3999-y
2. Cortegiani, A., Misseri, G., Fasciana, T., Giammanco, A., Giarratano, A., & Chowdhary, A. (2018). Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris. Journal of Intensive Care, 6, 69. doi:10.1186/s40560-018-0342-4
3. Jeffery-Smith, A., Taori, S. K., Schelenz, S., Jeffery, K., Johnson, E. M., Borman, A., … & Manuel, R. (2017). Candida auris: a Review of the Literature. Clinical Microbiology Reviews, 31(1). doi:10.1128/CMR.00029-17
4. Lee, W. G., Shin, J. H., Uh, Y., Kang, M. G., Kim, S. H., Park, K. H., & Jang, H. C. (2011). First three reported cases of nosocomial fungemia caused by Candida auris. Journal of Clinical Microbiology, 49(9), 3139–3142. doi:10.1128/JCM.00319-11
5. Satoh, K., Makimura, K., Hasumi, Y., Nishiyama, Y., Uchida, K., & Yamaguchi, H. (2009). Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiology and Immunology, 53(1), 41–44. doi:10.1111/j.1348-0421.2008.00083.x
The candid, detailed exegesis presented by the AKUH practitioners heralds an urgent call to arms against the advancing specter of C. auris. The shared understanding of the rapidity, mortality, and resistance can only be cemented with an international coalition of medical leaders bent on deterring this outbreak. As Pakistan and the global community continue their sentinel surveillance, the quintessential quest remains: To better understand, manage, and prevent the scourges of multidrug-resistant infections such as C. auris. Only through shared knowledge, concerted action, and relentless research can this microbial challenge be quelled.